May 21, 2014

What Will the Post-Antibiotics Future Look Like?

After 85 years, antibiotics are growing impotent. So what will medicine, agriculture and everyday life look like if we lose these drugs entirely?

Sir Alexander Fleming, the discoverer of penicillin, warned in 1945 as he accepted the Nobel Prize in Medicine,
“It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them… There is the danger that the ignorant man may easily under dose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” ….
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What worried him was the possibility that misuse would speed the process up. Every inappropriate prescription and insufficient dose given in medicine would kill weak bacteria but let the strong survive. ... Bacteria can produce another generation in as little as twenty minutes; with tens of thousands of generations a year working out survival strategies, the organisms would soon overwhelm the potent new drugs.
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With antibiotics losing usefulness so quickly — and thus not making back the estimated $1 billion per drug it costs to create them — the pharmaceutical industry lost enthusiasm for making more. In 2004, there were only five new antibiotics in development, compared to more than 500 chronic-disease drugs for which resistance is not an issue — and which, unlike antibiotics, are taken for years, not days.
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So what would a post-antibiotic era look like? It isn't hard to imagine what would happen first. Infected patients would die. In fact, they already do.

What else? Well, getting a tattoo, botox or liposuction would be far more fraught with danger.

Those calculations of risk extend far beyond admitting possibly contaminated patients from a nursing home. Without the protection offered by antibiotics, entire categories of medical practice would be rethought.
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"A post-antibiotic world means, in effect, an end to modern medicine as we know it. Things as common as a strep throat or a child's scratched knee could once again kill." Dr Margaret Chan, World Health Organization.
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Dr. Louis Rice, chair of the department of medicine at Brown University’s medical school. “Plus, right now healthcare is a reasonably free-market, fee-for-service system; people are interested in doing procedures because they make money. But five or ten years from now, we’ll probably be in an environment where we get a flat sum of money to take care of patients. And we may decide that some of these procedures aren’t worth the risk.”
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Out of all the antibiotics sold in the United States each year, 80 percent by weight are used in agriculture, primarily to fatten animals and protect them from the conditions in which they are raised…..

A growing body of scientific research links antibiotic use in animals to the emergence of antibiotic-resistant bacteria: in the animals’ own guts, in the manure that farmers use on crops or store on their land, and in human illnesses as well. Resistant bacteria move from animals to humans in groundwater and dust, on flies, and via the meat those animals get turned into.

In the Kenyon Review, Jacob Appel writes in Sudden Death: A Eulogy, "Sudden death is a conclusion. Too often, I fear, the long goodbye devolves into a negation."

The lingering long goodbye is how death is experienced today when every effort is made to prolong life using all the medical technology and modern medicines at the doctor's command.

In a post-antibiotic world, death will come much earlier and more quickly.